Us folks on the far left should a) actually listen to the folks on the far right and b) tell the truth. How many left/liberal folks have you heard stand up and belittle conservatives for jumping from a proposal for funding advance directives (i.e., living wills) to being concerned about “death panels”? A lot I imagine. Did any of these left/liberal folks ever take even 60 seconds to try to figure out where all you conservatives might have gotten the idea from — or consider that there might actually be some logic to seeing a link between those two things.

The link is Ezekiel J. Emanuel, M.D., Ph.D. Dr. Emanuel is Head of the Department of Bioethics at The Clinical Center of the National Institutes of Health. He is currently on extended detail as a special advisor for health policy to the director of the White House Office of Management and Budget. These are facts obtained from the National Institutes of Health. Other facts also available from the NIH website include that Dr. Emanuel developed The Medical Directive, a comprehensive living will that has been endorsed by Consumer Reports on Health, Harvard Health Letter, the New York Times, the Wall Street Journal, and many other publications. also, he has published widely on the ethics of clinical research, health care reform, international research ethics, end of life care issues, euthanasia, the ethics of managed care, and the physician-patient relationship in the New England Journal of Medicine, The Lancet, JAMA, and many other medical journals.

One particular publication by Dr. Emanuel is frequently cited by the far right is “Where Civic Republicanism and Deliberative Democracy Meet” in The Hastings Center Report, Vol. 26, No. 6, In Search of the Good Society: The Work of Daniel Callahan (Nov. – Dec., 1996), pp. 12-14. Official URL: –however, since you have to have a paid subscription to see the whole article at this URL, here’s an alternative that that has the entire (brief as it is) article in pdf format: The portion of this paper that is most frequently cited by those on the right is taken out of context from this larger quote:

Thus, it seems there is a growing agreement between liberals, communitarians, and others that many political matters, including matters of justice–and specifically, the just allocation of health care resources–can be addressed only by invoking a particular conception of the good. We may go even further. Without overstating it (and without fully defending it) not only is there a consensus about the need for a conception of the good, there may even be a consensus about the particular conception of the good that should inform policies on these nonconstitutional political issues. Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberative democracy. Both envision a need for citizens who are independent and responsibile and for public forums that present citizens with opportunities to enter into public deliberations on social policies. This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity–those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations–are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason. Clearly, more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services.[emphasis added]

So here we have a current advisor to President Obama, who is well known for developing the definitive living will (advance directive), who has also published work that refers to the use of “public forums” to make decisions about who should and who should not be guaranteed health care paid for with public dollars. [Note no where does it say that people would be denied health care, just that they would not be guaranteed public money for that care.] So if I’m a conservative, who has been trained since the days of Ronald Reagan to distrust everything about the federal government — except of course the military — and I dislike the current president intensely, perhaps because of his race or just because I think he’s a socialist and I’ve been trained from infancy to have a knee jerk reaction to socialists and socialism, then I learn these facts (above) about someone who is clearly in a position of influence on developing the health care plans of the current administration, well then….

I’m not saying that I is reasonable or correct to decide that a provision in the legislation to pay for a visit to your family doctor to discuss a living will is the same thing as advocating “death panels,” but I am saying that this connection did not come out of thin air, there is a logic — however, twisted — to it. This is why we should listen to the far right. The things they are concerned usually have some shred of truth and reality in them, even if they are highly distorted.

That gets me to part b) telling the truth. Read Dr. Emanuel’s short article. He is speaking truth — we cannot as a society afford to provide all the technologically, medically possible treatments to all the citizens of this society. We do not do it now. Now, we allow the problem of not having enough resources to provide all treatments to all people to be solved by corporations. We let Humana and Cigna and Blue Cross/Blue Shield determine what treatments will and will not considered “basic” and who will be entitled to care. Depending upon the state and on the insurance company, various studies estimate that between twenty and twenty-five percent of claims to insurance companies are denied as “medically unnecessary.” One example in a CNN article from two years ago was surgery for cleft-palates in children in the United States, are frequently denied as being for “cosmetic” purposes.

We should be honest, both the right and the left know that our society cannot afford to provide every possible medical treatment to every single individual in society. The difference between the right and the left is who they want to have make the decision and on what basis they want the decision to be made. The right wants private corporations to go on making the decision about who gets treatment and what treatment they get, and the right wants the basis of the decision to be a monetary decision, based on who has the money to pay. The left wants the citizens of the country to make decisions through the political process, and to based those decisions on societal consensus. What Emanuel suggests is that one criteria that might be used has to do with contributions and participation in society. But that is only one possibility, the idea is for members of society themselves to discuss and debate this and set ground rules.

I suspect that one of the problems that the right has with the left on this, is that folks who are conservative is basically distrusting of human nature, and do not trust their fellow citizens to make fair and equitable decisions. Another problem is that most people don’t want to be responsible for making decisions about life and death, they’d rather leave that to faceless corporations that they can then bitch about if they don’t like what happens, rather than feel responsible for the lives of others.